Hassan Sheikh is a Law & Policy Analyst for CHHS, and works full-time assisting the Baltimore City Department of Public Health.

Measles can present in a patient anywhere between 10 to 14 days after initial exposure to the virus. Symptoms can include fever, dry cough, runny nose, sore throat, inflamed eyes, or a skin rash. Although cases have become rare due to vaccination efforts (with the United States averaging about 60 cases of measles a year from 2000 to 2010), the CDC has reported 555 individual cases of Measles between January 1st to April 11, 2019, in over 20 different states.

Measles outbreaks, defined as 3 or more cases, are currently ongoing in New York State (Rockland County), New York City, Washington, New Jersey, California (Butte County), and Michigan. The majority of individuals who developed measles were unvaccinated.

Measles is highly contagious, and can be found in the air after an infected patient coughs or sneezes. The virus can remain contagious on surfaces for up to 2 hours; an individual can spread measles from 4 days before to 4 days after the signature rash develops. Any person who is in close contact with someone who has measles should be notified of the exposure, determine if they are susceptible to getting the disease, and receive treatment if necessary. A vaccination given within 72 hours of measles exposure may provide some protection from developing measles in some cases.

Measles can be prevented with a measles vaccine. Two doses of the vaccine are recommended for children, starting at 12 to 15 months of age. In Maryland, all school children in Kindergarten through Grade 12 must be vaccinated. Women should not get the vaccine if they are pregnant, or plan to get pregnant within 4 weeks after getting the vaccine. For more information regarding the vaccine, please click here.

If you suspect you may be in contact with someone who has developed measles, please contact your doctor or local health department immediately to be tested. The Baltimore Sun reports that anyone who has visited the following locations at these times may have been exposed;

4000 Old Court Rd in Pikesville on Sunday, April 14 from 10:30 a.m. to 1:30 p.m.

There have been two clinics in Baltimore wherein the measles vaccine was administered without cost to concerned individuals. There is no current word on whether there will be another clinic. Additional information regarding measles, including instructions on what to do if you think you may have been exposed can be found here.

On July 19th, 2019, the Prince George’s County Emergency Preparedness Program and Partners will facilitate a Full Scale Exercise to practice mass medication dispensing capabilities. We are currently seeking volunteers to serve as clients to walk through a point of dispensing (POD) at Largo High School. Volunteers will be needed from 9:00 am until 12:00 pm. Please sign-up below:

The NCAA Men’s Basketball Tournament concluded Monday night, in host city Minneapolis, with a thrilling overtime victory by the University of Virginia. Lost in the bright lights and confetti of Virginia’s victory however, were the immense security measures taken by the city of Minneapolis and event partners to ensure that the Final Four went off without a hitch. While events of this magnitude can bring tremendous publicity and economic windfall to the host cities, there are an incredible amount of security measures that need to be taken to prepare for a party of this size.

The Final Four drew a massive amount of people to downtown Minneapolis. 72,711 fans attended Saturday’s Final Four games alone, which notably does not include those without tickets who came downtown to participate in the festivities. For a city of only 422,000 people, a remarkable amount of coordination and planning is required to handle this influx in population. Security planning for a Final Four often spans longer than a year and across many state and private entities. Thirty different law enforcement agencies worked together to ensure the safety of the event. This year, law enforcement made an emphasis to have a large presence of uniformed officers to make attendees feel safe.

Security for an event of this magnitude can be expensive too, with an estimated cost of $1.3 million for the Final Four security enhancements. Minneapolis is no stranger to hosting large events, as the city recently hosted Super Bowl LII. However, there are fewer federal resources made available for hosting the Final Four. In order to help fill this gap, planners relied on a large number of volunteers, security cameras, and partnerships with private security firms. Law enforcement also relied on coordination with local bars and restaurants, and on attendees themselves, who were encouraged to speak up if they noticed anything suspicious.

Changes were made this year to attempt to provide a more fan friendly atmosphere for the Final Four as compared to the Super Bowl. The National Guard presence as well as some of the other increased security measures needed to host a Super Bowl made some notice the distinct “military feel” during the Super Bowl festivities. An event like the Final Four typically receives a Level III SEAR (Special Events Assessment Rating), which is a lower level rating than a Super Bowl, but a step up from a regular season professional sporting event. Still, the FBI had an estimated fifty to sixty local special agents, analysts, and support staff responsible for the Final Four.

While the level of security may have been lower than a Super Bowl, authorities still made sure to have a robust law enforcement presence and to make public safety a top priority. Fortunately, this preparation allowed the Final Four to go on without any major public safety issues. The weekend was considered to be a large success, with Minneapolis receiving a lot of praise for the event.

https://mdchhs.com/wp-content/uploads/2019/04/Final-Four-Stadium.jpg451680CHHS Research Assistants & Externshttps://mdchhs.com/wp-content/uploads/2018/12/chhs_logo_header.pngCHHS Research Assistants & Externs2019-04-12 13:41:012019-04-12 13:50:24Securing a Final Four

In 2013, Edward Snowden, a former Central Intelligence Agency (CIA) employee and former employee of Booz Allen Hamilton, a National Security Agency (NSA) contractor, leaked information regarding the United States’ (U.S.) government’s surveillance practices, which were used on both its own citizens and foreign individuals. Through different programs, the NSA collected both content and metadata of private communications. Notable programs include PRISM, governed by Section 702 of the Foreign Intelligence Surveillance Act (FISA), and the telephone records program, conducted pursuant to Section 215 of the United and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism (USA PATRIOT) Act.

Under PRISM, the government can obtain a FISA order from a Foreign Intelligence Surveillance Court (FISC), requiring an Internet services provider to disclose the contents of communications of a foreign individual. However, FISA orders are not search warrants under the Fourth Amendment, which require probable cause, and do not require a showing of probable cause that the target of the surveillance committed a crime. In fact, there is no requirement that the government have a reasonable suspicion that the target is involved with terrorist activities. Rather, the government must establish only that “a significant purpose of the acquisition is to obtain foreign intelligence information.”

Although PRISM “has not been as controversial [] in the U.S., because it does not target Americans, . . . some content from Americans’ communication gets caught in the dragnet.” The program collects private communications of Americans “incidentally” when Americans communicate with foreign targets. Furthermore, according to Section 702 of FISA, FISA orders may be authorized to “target[ ] persons reasonably believed to be located outside the United States.”

Despite outcry from privacy advocates, PRISM, which was set to expire, was renewed in January 2018.

Another controversial surveillance method is the phone records program, in which the NSA collects metadata in bulk from telecommunications companies. Metadata includes information such as when you made the call, whom you called, the duration of the call, and all the same information if you received a call.

Although seemingly less invasive than disclosing the contents of a call, metadata can be just as, if not more useful to the government. While “content generally requires labor-intensive human analysis to become meaningful to the intelligence agencies,” metadata can be analyzed by a computer, “easily provid[ing] a complete [profile] of all your personal associations and interests,” says Shayana Kadidal from the Center for Constitutional Rights. This profile can be so detailed, it can be more informative than the content of the communication itself. Additionally, this metadata is collected in bulk, meaning that, in the program’s original form, which was authorized by the USA PATRIOT Act, phone companies had to disclose all logs they collected about all customers. However, in 2015, Congress passed the Uniting and Strengthening America by Fulfilling Rights and Ending Eavesdropping, Dragnet-collection, and Online Monitoring (FREEDOM) Act, which renewed many portions of the USA PATRIOT Act that were set to expire, but with limits concerning bulk collection, due to backlash from the Snowden leaks. Under the FREEDOM Act, phone companies no longer have to automatically provide the government with all of their records. Instead, phone companies retain their records, and the NSA may request access to the records from a FISC under a “reasonable articulable suspicion” standard.

The Freedom Act has decreased the number of records collected, but the NSA still collects hundreds of millions of records per year—151 million call records in 2016 related to 42 terrorism suspects, and 534 million call records in 2017 related to 40 suspects.

Although PRISM is still in effect, portions of the USA PATRIOT Act that authorize metadata collection are set to expire in December 2019, and the NSA is considering allowing its expiration because the program lacks operational value, according to people familiar with the matter.

Furthermore, technical issues may have resulted in the unauthorized collection of information, forcing officials to “purge hundreds of millions of call and text logs [from the agency’s database that] it got from phone companies . . . .”

According to a podcast segment with Luke Murray, a national-security adviser for Republican congressional leadership, the program has not been used in six months and the NSA may not seek renewal of the portions of the USA PATRIOT Act that authorize it. Lack of use of the program and lack of interest in preventing its expiration seriously undermines the NSA’s previous claims that metadata collection is vital to national security.

However, deliberations are still in the early and informal stages, and earnest debate is not expected to begin until the fall. Furthermore, any final decision about whether to end the program would be made by the White House. Nevertheless, there are a multitude of reasons that support nonrenewal.

In 2014, the Privacy and Civil Liberties Oversight Board (PCLOB) released a report regarding the phone records program. In its report, the PCLOB recommended that the government end the program, in part due to the fact that the program has not contributed in a demonstrable way to the effort to safeguard the nation from terrorism. Out of fifty-four counterterrorism events in the summer of 2013, only twelve incidents involved the use of the 215 program. The PCLOB found that the program primarily provides value to the NSA in two ways, both of which relates to information already known by law enforcement. Furthermore, the PCLOB could not identify “a single instance involving a threat to the United States in which the telephone records program made a concrete difference in the outcome of a counterterrorism investigation.”

In any case, in instances in which phone records may be necessary to an investigation, there are alternative methods by which the government may gain access to the records, such as court orders, subpoenas, and national security letters (“NSL”), authorized by the Electronic Communications Privacy Act (“ECPA”). In addition, technological changes and advancements have also made the program less useful since its introduction, such as the major shift from landline to cellular technology.

Finally, the program has serious implications on peoples’ privacy and civil liberties. As mentioned above, metadata has the ability to “reveal intimate details about a person’s life, particularly when aggregated with other information and subjected to sophisticated computer analysis.” Permitting the government to collect such data “fundamentally shifts the balance of power between the state and its citizens.”

Big tech companies are currently self-regulated, but that could soon change. With members of Congress being younger and more diverse than ever before, it seems to be the perfect time to address the regulation of technology. Congress is currently holdings oversight hearings, and lawmakers are proposing new regulations in a crackdown on how big tech companies’ use and resell their customers’ personal information. The need to know what big tech companies are doing with consumers data is a growing need that policymakers have not adequately addressed in the past. Rep. Jan Schakowsky (D-Illinois) told NPR, “In the last two weeks alone, we learned that Facebook exposed individuals’ private health information that consumers thought was in a protected closed group, and collected data from third-party apps…on issues as personal as woman’s menstrual cycles and cancer treatment.”

The main motivation for stricter privacy regulations is that people want to know how these big tech companies are using their data. The more people are relying on technology and entrusting these companies with their private information, the clearer it becomes that Congress needs to step in and hold these companies accountable.

In the context of the current divisive political climate, it is rare for privacy regulation of tech companies to garner bipartisan support. On Tuesday, March 12, 2019, GOP Senator Josh Hawley (R-Missouri), questioned Google’s senior privacy counsel, Will DeVries, about Google’s tracking policy for the company’s Android mobile devices. It might be surprising to learn that even when users turn off their location tracking services, or even turn off their phone, the company is still gathering data about that devices’ location. DeVries defended this action by stating, “gathering location data is what makes maps work, what makes routing of calls work, and other functions.”

This issue is not exclusive to mobile devices. Social media platforms are constantly gathering data from its users as well. Social media platforms offer free access to users, once they agree to the terms and conditions. But are these services actually free? Big tech companies make billions of dollars each year by selling advertisers insight information from the data users share on their platforms. This data is gathered from the website users visit, the posts users like on social media, and even users locations.

Most users do not normally read the Terms of Conditions before agreeing to their terms. These terms are normally lengthy, filled with legal jargon and updated frequently, making it difficult for the average user to fully understand what they are agreeing to. Tech companies should be required to inform their users upfront what data they will be collecting and what they plan on doing with that information.

Currently, some states have taken it upon themselves to enact privacy legislation that is lacking at the federal level. However, due to the global reach of technology, separate state legislation would eventually be problematic for tech companies and consumers. Dave Grimaldi of the Interactive Advertising Bureau said, “The Internet is global, it most certainly goes over state lines. And I think that changing or altering the Internet experience to state to state would be something that would be a giant turnoff to consumers and just wouldn’t help anyone.”

Unfortunately, it is very unlikely that big tech companies will stop gathering data from users. Furthermore, having states coming up with their own solutions to this issue is not the answer, as it would create greater problems for tech companies and consumers. The best resolution would be for Congress to require big tech companies to disclose what they are doing with the data collected. Congress should also consider putting requirements in place for how and what information these companies can disclose to advertisers. In regards to the terms and conditions, companies should be mandated by Congress to simplify the wording for the common user that does not have a technology background. This standard could be in line with the reasonable person standard. It is important that Congress begin to regulate big tech companies in regards to the data they are collecting from users and what they are doing with that information. Without this regulation, users are disclosing more information than the may realize to data consumers who could potentially disclose that information in the long run.

Per- and polyfluoroalkyl substances (PFAS) are a group of man-made chemicals that include PFOA, PFOS, and GenX. PFAS are commonly found in packaging used for food, commercial household products, industrial work environments, drinking water and living organisms. PFAS presents a threat to public health because most people come into contact with PFAS and the chemicals can accumulate and stay in the human body for a long period. Harvard University researchers have reported that public drinking water supplies serving more than 6 million Americans exceed the EPA suggested threshold for PFAS. Studies indicate that PFOA and PFOS can impact infant birth weights, the immune system, and can cause cancer and thyroid hormone disruption.

On February 14th, the Environmental Protection Agency announced a refined plan to address a set of “forever chemicals” that have long posed a threat to millions to Americans. The PFAS Action Plan establishes three overarching goals: (1) provide both short-term solutions and long-term strategies to address this important issue (2) provide a communication plan to address this emerging environmental challenge and (3) respond to the extensive community engagement inputs and public docket letters. However, many environmental groups and impacted communities have found that the “action plan” falls short in regulating these toxic chemicals. Impacted communities have stated the suggestive measures set forth by EPA are not sufficient and that binding maximum exposure limits should be established and enforced. This initial action by the EPA is merely a start to the process of regulating these harmful drinking water contaminants, and enforceable limits seem to be a distant reality.

Because the regulatory process is often slow and burdensome (experts estimate that setting a federal limit to PFAS exposure under the federal rulemaking process can take as long as ten years), States have been forced to take the lead in addressing PFAS exposure. Thus far, however, only New Jersey has formally adopted PFAS drinking water standards toxic chemicals. New Jersey has set the Maximum Contaminant Level (MCL) to 13 parts per trillion as recommended by the New Jersey Drinking Water Quality Institute. At least another seven states have policies or have indicated that they plan to pursue policies stricter than the EPA’s current health advisory of 70 parts per trillion.

The courts are also serving as an avenue for change and progress to address toxic chemicals. Thus far, courts have focused on Military Sites because they are commonly known to have PFAS contamination. The Department of Defense has identified approximately 400 current or former military sites with known or suspected contamination. This past October, affected communities in Pennsylvania won a major victory in a Third Circuit ruling addressing a lawsuit against the United States Navy. The judicial decision will ultimately allow individuals whose drinking water was contaminated with PFSA chemicals from neighboring Naval military bases to proceed with their lawsuits against the U.S. Navy. The Third Circuit recognized the damaging effects of toxic chemicals released from the military bases, and asks the Navy to pay for medical surveillance of exposed families so that serious health problems associated with exposure to chemicals can be detected early.

PFAS has been around for decades and their toxicity levels and impacts on human health are now being brought to light. It is important that government officials move forward with stringent regulations, and where they are not willing, that state governments step in to protect public health.

https://mdchhs.com/wp-content/uploads/2019/03/PFOA-Chemicals.jpg6661353CHHS Research Assistants & Externshttps://mdchhs.com/wp-content/uploads/2018/12/chhs_logo_header.pngCHHS Research Assistants & Externs2019-03-25 08:28:292019-03-25 10:39:22EPA’s New Plan To Address Toxic Chemicals In Drinking Water Falls Short

Several CHHS staff members will share their expertise with public health preparedness professionals nationwide as presenters at the 2019 Preparedness Summit on March 26th & 27th in St. Louis, MO. Please see the schedule and hyperlinks below for details.

If you are attending the Summit, we hope to see you at our presentations!

Presentation: When Should a Public Health Crisis be Declared an Emergency? A Look at Using Emergency Powers to Combat Public Health Issues Like the Opioid Crisis

Using the opioid overdose crisis as a case study, this presentation examines state emergency powers, their practical use in combating opioid overdoses, and potential impacts emergency declarations may have on combating this and other public health crises.

Learn about the critical role childcare providers and educators can play in response and recovery, and how public health officials and emergency responders can utilize and support this key resource to enhance children’s well-being and build community resilience. Workshop ideas, experiences, and best practices with other professionals in the field.

The National Capital Region (NCR) assessed its regional vulnerabilities in providing emergency medical countermeasures (MCM) to its population during a widespread biological incident. Other jurisdictions may adopt the NCR’s assessment process to identify and prioritize MCM response vulnerabilities for their future regional preparedness efforts.

The CDC reported in 2018 that the drug OxyContin (oxycodone) is one of the top opioid drugs used in this country, and often leads to cases of overdose and/or death. As lawsuits against Purdue Pharma, the company that developed OxyContin, solidify, new information has surfaced that Dr. Richard Sackler, a member of the family that founded and controls Purdue Pharma, was involved in spreading false information.

These lawsuits are far from over as our country continues to worry about the opioid crisis. On October 26, 2017 President Trump declared the “opioid crisis a national public health emergency under federal law.” However, in order to see change, the company and its’ leaders who fostered this epidemic must take further responsibility for actions that were intentional and lead to an abuse of this opioid.

OxyCotin, which was developed in 1995 and launched in 1997 by Purdue Pharma, is a strong narcotic that is used to relieve pain, but it also heavily abused recreationally. Since August of 2018, at least 27 states – interestingly Maryland is not one of them- have decided to fight this epidemic and go after Purdue Pharma for misleading marketing campaigns and minimizing the seriousness of the drug.

Back in 2007, Purdue Pharma settled with the government and plead guilty to “misbranding OxyCotin.” They were forced to pay over $600 million for the criminal damages. Purdue Pharma admitted that they understood the risk of addiction and the strength of OxyCotin. Nonetheless, this guilty plea was largely overlooked by public opinion as the sale of OxyCotin continued to increase over the next several years.

Further, Purdue Pharma’s culpability in the opioid epidemic was largely forgotten until 2018 when a copy of a confidential Justice Department report showed that federal prosecutors who were “investigating the company found that Purdue Pharma knew about “significant” abuse of OxyContin in the first years after the drug’s introduction in 1996 and concealed that information.”

Now, information that Sackler supported and aided in the decision to suppress the truth about OxyCotin is being made public. An email exchange between Sackler and Michael Freidman, the head of sales and marketing and the person who came to Sackler and received input on the decision not to correct the false information, is now surfacing.

“It would be extremely dangerous at this early stage in the life of the product…to make physicians think the drug is stronger or equal to morphine… we are well aware of the view held by many physicians that oxycodone [the active ingredient in OxyContin] is weaker than morphine. I do not plan to do anything about that.”

Sackler responded that the “agreed” with Friedman and let the myth continue.

This exchange, along with other comments made by Sackler, are now being requested as a result of lawsuits being filed by “hundreds of cities, counties, states, and tribes” against Purdue Pharma. These suits all revolve around the drug, and more specifically, the Sackler family’s history of misleading medical professionals, and in turn patients, about the strength and thus recommended dosage of the drug. An example of one of these lawsuits is the Massachusetts complaint, which was made public in January 2019 and exposed the Sackler’s involvement, particularly Richard Sackler, in the way that OxyCotin was marketed to the public.

Purdue Pharma continues to support the Sackler family. The Sackler’s and Purdue Pharma maintain that “…the company accurately disclosed the potency of OxyContin to healthcare providers” and on the label of the drug it is “made clear that OxyContin is twice as potent as morphine.”

https://mdchhs.com/wp-content/uploads/2019/03/Oxycontin.jpg540960CHHS Research Assistants & Externshttps://mdchhs.com/wp-content/uploads/2018/12/chhs_logo_header.pngCHHS Research Assistants & Externs2019-03-07 15:37:072019-03-07 15:40:27Updates on the Purdue Pharma Saga: Founding Family Member Dr. Richard Sackler Went Along with Plan to Conceal Drugs’ Strength

This week, cybersecurity experts from the University of Maryland Center for Health and Homeland Security (CHHS) provided their opinions about legislation up for debate in the Maryland General Assembly. The bill, cross-filed as HB 706 and SB 919 – “Absentee Ballot Requests, Delivery, and Marking”, would address widespread security concerns by enacting a practical limit on the population of voters who can request absentee ballots receive them electronically. Currently, Maryland allows all registered voters to request an absentee ballot online and then have their ballot emailed to them. While convenient for many voters, this method is an easy target for fraud committed using a man-in-the-middle attack. The bills under consideration would dramatically limit this vulnerability by requiring voters apply to qualify for an e-mailed ballot by either showing that they qualify under the federal laws such as the Americans with Disabilities Act or Uniformed and Overseas Citizens Absentee Voting Act, or showing that they would otherwise be unable to vote.

CHHS Founder & Director Michael Greenberger and Senior Law & Policy Analyst Netta Squires were invited to provide written and oral testimony, respectively, for members of the House of Delegates who are considering a vote on the bill. In a packed hearing room, the Committee on Ways and Means listened to comments on the proposals intended to improve election integrity by addressing issues with absentee ballot rules. Absentee ballots are regarded as a particularly vulnerable part of any election system, as was highlighted by the revelations in the latest North Carolina election.

CHHS Senior Law & Policy Analyst Netta Squires

After reports of irregularities in absentee ballots raised enough questions in a close vote tally, the State Board of Elections decided to not certify a winner in the Congressional Representative race in the 9th District. Following months of investigations, the State Board of Elections announced that there will be a new election later this year. Leslie McCrae Dowless, hired by candidate Mark Harris’s campaign to manage get-out-the-vote operations, allegedly took advantage of absentee ballot rules to cast hundreds of votes illegally in favor of his candidate. In February, Dowless was indicted by the local district attorney’s office for violating state laws by illegally possessing and submitting absentee ballots in the spring of 2018.

Election security has been a major issue around the world since at least 2016, when the public became aware of Russian interference attacks on multiple fronts. Maryland itself has had its State Board of Elections system probed by Russian government agents in recent years. While the Department of Homeland Security (DHS) and US intelligence community have fortified defenses against foreign interference, the fact is that most control of election security and laws rests in the hands of states and localities. As Netta Squires explained in her testimony, “The responsibility of making the election system more secure falls not only on DHS but also on officials in all levels of government.”

Legislation similar to HB 706/SB 919 has come to the General Assembly before, but did not move out of committee. One concern was that the proposed restrictions were too limiting and that some voters who are honestly dependent on absentee ballots would be disenfranchised. Netta Squires commented that the 2019 version of the bill adds language that broadens the population of voters who can benefit from online voting, without becoming unnecessarily broad. This is an improvement over the previous versions, as it balances concerns of exposing online voting to low-tech hacking threats with possibly leaving out voters who need absentee and online voting to have their voice heard.

On May 23rd, 2019, CHHS will help facilitate a Full Scale Exercise on behalf of the Region V Hospital Coalition. We are currently seeking volunteers to serve as mock patients. Please sign up to volunteer below:

About CHHS

The University of Maryland Center for Health and Homeland Security (CHHS) is a non-profit consulting group and academic center committed to maximizing organizational resilience before, during and after an emergency event.